The Use of 3D Motion Capture for the Quantitative Assessment of Surgical Tool Motion in Expert Laparoscopic and Naïve Surgeons

Abstract

Study Objective This proof-of-concept study sought to evaluate the efficacy of using quantitative variables derived from 3D motion analysis to differentiate laparoscopic surgical skill level. Design Observational case-control. Setting Simulation-based setting; surgical task completion. Patients or Participants Expert laparoscopic surgeons (n=7) and naïve surgeons (n=10). Interventions Participants were recruited to complete the Fundamentals of Laparoscopic Surgery (FLS) peg transfer task. Measurements and Main Results All participants watched an instructional video prior to data collection and completed the task three times. A 3D motion capture system recorded trajectories of retroreflective markers placed on two Maryland graspers and location of surgical tool tips were computed relative to a box trainer. Variables of interest: completion time, surgical tool translation (sagittal, frontal, coronal planes, surgical tool pathlength, and symmetry ratios (non-dominant vs. dominant tool motion). Independent one-tailed T-tests evaluated significant between group differences at the p<0.05 level. Experts completed the task with significantly shorter (mean±stdev) times (119.4±61.7s) (p=0.007) compared to naïve surgeons (201.9±78.4s). This is complemented by significantly shorter tool pathlengths (dominant=195.1±108.7cm; non-dominant=187.1±103.9cm) (p=0.038,0.004) and more symmetrical grasper use (symmetry ratio=0.95±0.19) (p=0.019) in experts compared to naïve surgeons (dominant=297.6±110.7cm; non-dominant=356.9±118.3cm; symmetry ratio=1.24±0.29). No between group differences in surgical tool tip translations were observed. Conclusion 3D motion variables can be used to quantify between group differences in surgical tool motion. Not only did expert surgeons complete tasks more quickly, they also moved more efficiently and displayed more symmetrical use of their hands compared to naïve surgeons, who had greater movement of their non-dominant hands during the task. Objective, quantitative methods allowing trainees to improve surgical skill outside the OR are critical to ensure the highest possible standard of care is provided to patients. However, current evaluation models lack feedback relating to quality of movement. We believe motion capture can be a valuable adjunct to current skills acquisition models to improve self-directed surgical education and resident technicity. This proof-of-concept study sought to evaluate the efficacy of using quantitative variables derived from 3D motion analysis to differentiate laparoscopic surgical skill level. Observational case-control. Simulation-based setting; surgical task completion. Expert laparoscopic surgeons (n=7) and naïve surgeons (n=10). Participants were recruited to complete the Fundamentals of Laparoscopic Surgery (FLS) peg transfer task. All participants watched an instructional video prior to data collection and completed the task three times. A 3D motion capture system recorded trajectories of retroreflective markers placed on two Maryland graspers and location of surgical tool tips were computed relative to a box trainer. Variables of interest: completion time, surgical tool translation (sagittal, frontal, coronal planes, surgical tool pathlength, and symmetry ratios (non-dominant vs. dominant tool motion). Independent one-tailed T-tests evaluated significant between group differences at the p<0.05 level. Experts completed the task with significantly shorter (mean±stdev) times (119.4±61.7s) (p=0.007) compared to naïve surgeons (201.9±78.4s). This is complemented by significantly shorter tool pathlengths (dominant=195.1±108.7cm; non-dominant=187.1±103.9cm) (p=0.038,0.004) and more symmetrical grasper use (symmetry ratio=0.95±0.19) (p=0.019) in experts compared to naïve surgeons (dominant=297.6±110.7cm; non-dominant=356.9±118.3cm; symmetry ratio=1.24±0.29). No between group differences in surgical tool tip translations were observed. 3D motion variables can be used to quantify between group differences in surgical tool motion. Not only did expert surgeons complete tasks more quickly, they also moved more efficiently and displayed more symmetrical use of their hands compared to naïve surgeons, who had greater movement of their non-dominant hands during the task. Objective, quantitative methods allowing trainees to improve surgical skill outside the OR are critical to ensure the highest possible standard of care is provided to patients. However, current evaluation models lack feedback relating to quality of movement. We believe motion capture can be a valuable adjunct to current skills acquisition models to improve self-directed surgical education and resident technicity.